When a person becomes obsessive about slimming or
takes up dieting after food binges there may be cause for alarm. These
habits can become compulsive and turn into anorexia nervosa - a
potentially fatal condition.

Anorexia nervosa is commonly known as the 'slimmer's disease', but
its cause is far more complex than any simple desire to lose weight and
its long-term effects can be drastic, even life-threatening.

It generally strikes young people between the ages of 11 and 30, and
affects more girls than boys. Those from better-off homes seem more
prone to it than those from less affluent ones.

Dramatic loss of weight is the obvious sign that something is wrong,
and the person may need hospital treatment if the condition has reached
a really serious stage. In the long term, the underlying causes must be
diagnosed and remedied if treatment is to work and any improvement in
weight and health is to be maintained.

CAUSES
Once rare, anorexia nervosa has increased in the past 30 years. The
parents of victims may find it difficult to understand its cause, but
more often than not the problem lies within the family. A daughter who
never rebels or gives trouble, who delights her parents in every way and
seems part of a perfect family, may be secretly tortured by a lack of
confidence, self-esteem and a true idea of herself.

Such a girl may be too submissive and anxious to please for her own
good. Unwittingly, her parents may have brought this about by being
over-protective, deterring her normal adolescent drive towards
independence and a separate identity.

Psychiatrists believe that such teenage girls may have a deep-seated
fear of adult responsibilities and a fear of sexuality. As their own
bodies begin to show the signs of sexual maturity at puberty, they
subconsciously yearn to escape from the adult world and revert to a
neutral, asexual child-like figure.

Some girls diet drastically to increase their sexual confidence. They
cling obstinately to the distorted idea that their extreme emaciation is
beautiful, ignoring the harrowing evidence to the contrary which is only
too obvious to everyone else.

The popular image of slimness and superficial prettiness that is
promoted by films, advertising and television may give, a girl exactly
the justification she is looking for to account for her rejection of
food. She may not be overweight at all.

DANGERS

Experience has shown that the
more distorted an idea the victim has of herself, the more difficult the
cure, and the longer the condition goes untreated the more uncertain the
outcome. In the past, death rates of from five to 25 per cent have been
reported, but better understanding of the causes may improve the
situation.

Anorexia nervosa must never be lightly dismissed as a passing fad or
phase, which time and maturity will cure. The anorexic is not mature,
nor is she suddenly likely to become so. Spontaneous cures rarely happen
because the victim takes a positive pride in sustaining her hunger
strike.

The longer the illness lasts and the more weight is lost, the greater
the sense of achievement. This deepens in the anorexic the illusion that
being thin is making her significant and outstanding as an individual.
In more real terms it is also succeeding in focusing attention and at
last providing a form of personal rebellion against parental authority
that should have been made much earlier - and in a less dangerous form -
as part of growing up.

COMPULSIVE DIETING
When a normal person embarks on a diet they can stop when the desired
weight is lost. But the anorexic, once set on a course of
self-starvation, cannot go into reverse. They seem to be 'spaced out' -
like those on alcohol or drugs - with a similar light-headedness.

Anorexics have a different mental outlook and confused motives that
often involve self-punishment and also punishment of their parents.

SYMPTOMS
It is vital that the illness is recognized and that treatment is started
as soon as possible. This is not easy in the initial stages until the
weight loss becomes so obvious that it is clear that something is
severely wrong and a visit to the doctor is needed. Once a girl's weight
has fallen some 12kg (about 2 stone) below normal an unmistakable
symptom is that her
periods stop.

It may be discovered that she is making herself vomit, either to get rid
of food she has been coaxed to eat or as part of a 'binge-and vomit'
pattern, enabling her to indulge in food without putting on the dreaded
weight. In the end, the body becomes so accustomed to existing on a
greatly reduced amount of food, that it has difficulty coping with a
large meal.

In a few cases, anorexics use emetics, laxatives, diuretics and even
enemas, and over a period of time they can badly disturb their body
chemistry and increase the risk of a fatal outcome. Obviously, prolonged
starvation can mean a general weakening in victims and a greater
susceptibility to infection.

TREATMENT
Alert families should call for medical help long before symptoms are
acute. The first job is to restore weight above the danger level, before
other forms of treatment can commence. American research suggests a
critical weight of 41 to 43 kg (90 to 95 lb) must be achieved before
psychotherapy can penetrate the strange mental isolation that starvation
imposes and allow real communication.

Weight gain for the anorexic often requires a prolonged stay in
hospital, with intravenous feeding in the early stages. To coax the
patient to eat normal food and gain a set amount of weight, a system of
rewards and withdrawals of privileges has been widely used. The basis
for rewards is often a list drawn up by the patient and includes such
things as being allowed to get up to go to the toilet, having extra
visitors, wearing day clothes, going home on leave or, finally, going
home altogether.

Increasing weight successfully at home is made difficult by the extreme
cunning of anorexics. They will deceive parents into believing they are
eating a main meal at school or at work, and at home will toy with food,
pretending to eat while secretly smuggling it away in pockets or a
handkerchief.

FUTURE ACTION
Once some weight has been gained, the more difficult part of the
treatment can begin. This will include some family counselling, so that
parents and patient can understand the nature of the illness and learn
to cope with it.

Initially the victim has to be convinced that anorexia nervosa is not
just a matter of weight loss. Helped by a therapist, the girl can then
begin her search for identity, dealing with the inner doubts and fears
that plagued her, and appreciating the real promise of her sexuality and
maturity.

She must be helped to realize that her old ideas about herself were
distorted and learn to replace them with a truer picture. With this will
come the self-confidence to grow up emotionally.